In the spring of 1877 T.M. Greenhow, a retired surgeon, published an article in the British Medical Journal on the case of Harriet Martineau, who had died in her house in Ambleside the previous summer. Greenhow hoped to settle a heated debate about Martineau’s medical history that had been ignited – or rather, reignited – by some disparaging remarks about doctors which Martineau had managed to circulate posthumously. Greenhow’s principal evidence was a detailed autopsy report, written by another physician, that described the removal of ‘a vast tumour’, measuring 12 inches by ten, from her left ovary two days after her death. Greenhow also happened to be Martineau’s brother-in-law, though she had permanently broken with him 32 years earlier, after he published an article on her condition whose clinical specificity as to her symptoms, from ‘irregular uterine discharges’ to constipation, had offended her almost as much as its attempt to discredit her conviction that after five years as a hopeless invalid she had been cured of a fatal tumour by mesmerism.

Though the ‘organic or functional derangement of the uterus’ Greenhow had diagnosed in that article turned out to be a benign tumour of the ovary, the results of the postmortem vindicated his belief that the cause of Martineau’s previous symptoms had never disappeared, only shifted position, and that the tumour’s increasing pressure on her heart and other organs had finally killed her. Described in the autopsy report with homely concreteness as a ‘pear-shaped’ vessel that released ‘about half a pint of brown fluid’ when cut, and whose remaining contents could only be compared to ‘bread soaked in tea, dotted here and there with white hardish pieces, exactly like half of apple-pips’, Martineau’s tumour served for Greenhow – and most of the other doctors who joined the debate – as conclusive proof that her faith in mesmeric treatment was an illusion. Later that same month, Thomas Spencer Wells, a prominent specialist in ovarian diseases, delivered a lecture on the case to the Clinical Society of London, in which he described the growth itself – displayed for the audience together with a specimen bottle of its contents – as common enough and ‘not of much interest to the morbid anatomist’.

Having suffered from a variety of physical ailments since her early childhood, Martineau had long been familiar with the ‘impassable gulf between the experience of the sick and the well’ – and in this case the phenomenological gap was even greater than the doctors supposed. Though Greenhow was intent on showing that his sister-in-law had been wrong to believe herself fatally ill when she first felt the effects of her tumour in 1839, the conviction that she was about to die seems to have struck the patient herself as distinctly liberating. Life in the Sick-Room, the book that she wrote while believing herself to be dying of her uterine complaint, contends that ‘the abolition of the future’ is a ‘great and strange blessing’ to invalids: not so much because it promises an end to their suffering, but because it allows them to concentrate on the present – ‘our interests are all occupied with immediate and pressing objects, in which we have ascertained our true life to consist.’

Among those ‘pressing objects’, though she did not say so, was Life in the Sick-Room itself. Written in 1843 and published anonymously the following year, it was almost immediately recognised as her work. ‘I never wrote any thing so fast as that book,’ she was to say in her Autobiography: ‘I was hardly conscious of the act . . . so strong was the need to speak.’ And although she repudiated both the ‘morbid’ state of mind in which Life in the Sick-Room was written and the ‘youthful vanity’ with which the ailing and ‘pious’ child had anticipated her swift translation to heaven (‘I hoped for, and expected early death till it was too late to die early’), the Autobiography, too, owed its existence to Martineau’s belief that she was about to die. Convinced that she was ‘again ill, as hopelessly, and more certainly fatally’, this time from heart disease, Martineau set about writing both her life history and her own obituary at the age of 53 – only to survive for another 21 years. The Autobiography, now generally regarded as her greatest achievement, was finally published in 1877, after her death. (It was her attack in the obituary on the medical profession that had reignited the old controversy about mesmerism.)